草酸鈣部份鹿角結石與化膿性椎間盤炎-病例報告

吳政陽¹、曾啓新²、李苑如^2*

國立台灣大學醫學院附設醫院 ¹教學部，²泌尿部

Calcium oxalate partial staghorn stone with pyogenic spondylodiscitis – A Case Report

Cheng-Yang Wu¹, Chi-Shin Tseng², Yuan-Ju Lee^2*

Department of Medical Education¹ and Urology², National Taiwan University Hospital, Taipei, Taiwan

Introduction: The association between renal stones and spondylodiscitis is rarely discussed. We demonstrate the findings of calcium oxalate partial staghorn stone in a 62-year-old male who later developed thoracic spondylodiscitis and epidural abscesses requiring surgical intervention.

Case history: A 62-year-old male suffered from gross hematuria, intermittent fever, and left flank pain. He came to the urology outpatient department, where acute pyelonephritis was diagnosed, and a left partial staghorn renal stone was seen on computed tomography (CT). Oral antibiotics were prescribed with improvement, and surgical intervention was suggested. Two weeks after antibiotics treatment, he developed acute onset bilateral lower limb weakness and numbness under the nipple level. He was brought to the emergency department, where leukocytosis and pyuria were shown, and the spine MRI revealed T2-T3 spondylodiscitis with epidural abscess and spinal cord compression. He underwent T2-T3 laminoplasty/pediculectomy/facetectomy and discectomy, with improvement in muscle power and hypesthesia. The culture of the surgical lesion yielded Citrobacter koseri, the same as the urine culture obtained at his first visit. Left-side percutaneous nephrolithotomy (PCNL) was performed one month after cefmetazole administration, with successful stone removal and resolution of pyuria. Stone analyses reported the composition of calcium oxalate. Follow-up MRI showed marked improvement with resolution of spinal stenosis and epidural abscess. The patient was discharged, and follow-up urine analyses showed negative pyuria.

Conclusions: Urinary tract infection resulting from partial staghorn stone, with additional hematogenous spread to CNS causing spondylodiscitis, is scarcely discussed. The case we illustrated was that a calcium oxalate stone, which belongs to Jensen’s classification type 1, should be present in clean and sterile urine. However, a urinary tract infection could be seen in urine stasis or urinary tract obstruction. Citrobacter koseri-related UTI and spondylodiscitis have been described, with few case reports. With accurate diagnosis and essential surgical interventions, the patient had immediate neurological improvement and reached disease-free status.